Let me begin with a expression of frustration re technology: It is now Sunday morning, the 28th. Yesterday morning, very early before leaving for Logan to spend the day on a plane, I wrote a blog that somehow did not make it. What happens to words when written and not captured? Reminds me of how single socks vanish from the dryer, and we are all left with singletons. When my daughters were small, they had a book called The Attic of the Wind, and that was the place where all the missing socks (and words?) went.
To business: this is a report of a recent study out of the University of Toronto about the different perspectives of physicians, presumbably, medical oncologists, and women with Stage IV breast cancer about the value of treatments. This suggests that they hold different periods of time to be most important in considering success. Not surprisingly, women want/need more time of a specific treatment's working to believe that it was valuable. Doctors settle for less time. This likely is both a reflection of the physicians' understanding of the realities and difficulties with science, and women's insistence that we do better. Here it is:
7th European Breast Cancer
Barcelona, Spain, 24-27 March 2010
Abstract 63: A comparison of physician and patient perceptions of clinically important endpoints in the treatment of Metastatic Breast Cancer (MBC)
Citation: European Journal of Cancer Supplements Volume 8, No.3, March 2010, page 77 A. Sheik-Yousouf 2, S. Dukhovny 1, S. Verma 2
1University of Toronto, Department of Medicine, Toronto Ontario, Canada
2>University of Toronto Department of Medical Oncology, Sunnybrook Odette Cancer
Centre, Toronto Ontario, Canada
Background: To examine and compare the clinical trial endpoints physicians and patients consider to be important in MBC treatment decision making, amongst a cohort of Canadian oncologists and patients.
Methods: 28 breast oncologists responded to a secure, anonymous, and self-administered online survey. 52 Patients with MBC were also surveyed through a self-administered paper survey. Results were assessed using descriptive statistics.
Physician results: In the first line MBC setting, 52% believed overall survival (OS) was the most important endpoint considered in choosing a specific therapy, and 48% believed progression-free survival (PFS) was the most important. 48% thought that a minimum meaningful incremental improvement in OS from a first line MBC therapy was 4-6 months, and 44% believed 2-4 months was meaningful. 60% of oncologists believed that their patients also consider improvement in OS to be the most important endpoint, and 36% believed that overall QOL is the second most important factor to patients with MBC.
Patient results: The vast majority of patients believed the primary goal of their treatment(s) was to prolong life (88%). 63% also believed slowing tumour growth was a goal of treatment; shrinking tumour burden, and improving quality of life were also considered goals of treatment according to 62% of patients. 50% felt improving symptoms and pain were important therapeutic goals. 54% of patients believed prolonging survival was the most important endpoint in accepting MBC therapy, and 17% thought shrinking tumour size was the most important. In considering a new treatment for MBC compared to standard options, 46% of patients thought more than 12 months was the minimum improvement in overall survival (OS) they would consider as making the treatment worthwhile, 17% thought 10-12 months was acceptable, and another 10% thought only 1-2 months would be a minimal acceptable improvement in OS.
Conclusions and Discussion: Over half of patients and physicians surveyed consider OS as the most important endpoint in accepting therapy for MBC. However, physicians appear to consider much smaller absolute improvements in OS and PFS (2-6 months) as significant enough to adopt therapies, while almost half of patients required a greater than 12 month improvement in OS to consider a treatment worthwhile. This study is limited by small response numbers. Nonetheless, the data highlights disparities between oncologists and patients in the relative ranking of defined therapeutic endpoints, and in MBC treatment expectations. It thus emphasizes the ongoing need for thorough discussion of treatment goals with patients and for clinical trials to bring about meaningful results to both patients and physicians alike.